Provider Demographics
NPI:1013981935
Name:ADVANCED BEHAVIORAL CARE, INC.
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLE-BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-478-2780
Mailing Address - Street 1:1545 E 3300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3370
Mailing Address - Country:US
Mailing Address - Phone:801-478-2780
Mailing Address - Fax:801-478-2781
Practice Address - Street 1:1545 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3370
Practice Address - Country:US
Practice Address - Phone:801-478-2780
Practice Address - Fax:801-478-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0055526XXMedicare ID - Type Unspecified